Anja Manishin (right) inserts a needle into the back of Alicia Parlette's hand. An I.V. with her chemotherapy drug will be started and take about an hour to be fully absorbrd by her body. Kate Ferrogaiaro (cq) a life long friend of Alica's holds her hand.
Alicia Parlette is going through another round of chemotherapy.
FRIDAY, JANUARY 26, 2007 KURT ROGERS/THE CHRONICLE SAN FRANCISCO THE CHRONICLE
SFC ALICIA_0047_kr.jpg
Ran on: 02-02-2007
Nurse Anja Manishin (right) administers an IV as Kate Ferroggiaro (left) holds Alicia's hand.

Photo: KURT ROGERS /THE CHRONICLE

Anja Manishin (right) inserts a needle into the back of Alicia...

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Alicia with a smile on her face after her nurse Anja Manishin found a good vein to start the I V.
Kim Ferrogaiaro Alicia's long time friend (left) Alicia Parlette is going through another round of chemotherapy.
FRIDAY, JANUARY 26, 2007 KURT ROGERS/THE CHRONICLE SAN FRANCISCO THE CHRONICLE
SFC ALICIA_0110_kr.jpg MANDATORY CREDIT FOR PHOTOG AND SF CHRONICLE / -MAGS OUT

Photo: KURT ROGERS/THE CHRONICLE

Alicia with a smile on her face after her nurse Anja Manishin found...

ALICIA'S STORY / Goodbye, interferon, hello, chemo -- new step in the journey

I sat across from my oncologist, Dr. Thierry Jahan, as he spoke. We -- my dad; my surrogate mom, Sally; and I -- had just found out that my cancer had, once again, grown "just a little" in my right glute and both lungs.

No surprise to me. This kind of increase had been showing up on scans for a year and a half, ever since the spring of 2005, when I learned I have alveolar soft part sarcoma, a rare cancer that is slow growing but very difficult to treat.

After meeting with several UCSF doctors -- and even flying to Houston for a second opinion -- I had ended up on interferon, a drug meant to slow or stop the growth. I had stayed on it through gamma knife radiation, when I had two tiny spots on my brain zapped (with no return); through the increased fatigue -- a side effect of interferon -- when we coupled the drug with potent, drowsy-making painkillers; and through each scan that showed the cancer growing a little bit more.

Now Dr. Jahan was saying that the growth was no longer acceptable, no longer something to try to contain with the interferon. All the little growths had added up to one big choice.

So this day, we were talking about options.

First Dr. Jahan mentioned Doxil, which contains Adriamycin.

"Adriamycin?" I said. "The chemo drug?" A drug my mom, who died of non-Hodgkin's lymphoma, had used.

He said Adriamycin itself is different, used for more aggressive cancers.

"So it's not Adriamycin?"

"It is Adriamycin. It's Adriamycin wrapped in fat. That's why it's a pig in a blanket."

I couldn't believe I was so calm, even as we were talking about chemo options. We had put chemo at the back of our minds months ago; it doesn't seem to be very effective in ASPS patients. Since it's so toxic and distressing to the body, I wanted to steer clear of it. It seemed a choice with too much cost for the benefit I could receive.

There was another "chemo-ish" option, as Dr. Jahan called it: a pill called Temodar. It's taken daily, and thus slowly builds up in the system. The upshot: When the cancer cells decide to act out and replicate like over-fertile rabbits, a sizable amount of Temodar is there to stop them. That's a comforting thought.

That made Temodar seem like a better choice; steadier, more constant.

Silently I kept saying, "I'm ready, I'm ready" -- even while Dr. Jahan spoke about the nasty side effects -- and I was talking about the Doxil. I was talking about my mother's drug.

Sentimentality, I realize, is no good way to choose a cancer treatment. However, I had asked Dr. Jahan lots of questions about the science of both drugs; we all had. Both have a promising modus operandi: They were both released slowly, resulting in a somewhat steady treatment in my body. (Slow-growing cancers really don't respond well to fast-acting drugs.)

But the bottom line was that neither drug had been used often for alveolar soft part sarcoma, and Dr. Jahan had never used Temodar for ASPS. So basically, as far as decision making went, the science was moot.

"You pick one based on what your lifestyle is like," he said.

I looked at him, dumbfounded. "That's a weird way to pick a cancer treatment, don't you think?" I said. He shrugged.

Besides, what lifestyle? It's not as if I took off on mini-vacations every few weeks and couldn't work in a round of chemo. I went to work, cared for myself and my dog, and went to support activities based on what the side effects of my current treatment would allow. I had no lifestyle outside of cancer.

If I was going to pick a treatment based on lifestyle, then I might as well pick it based on emotional attachment. If I want to bond with my dead mother via toxic drugs, so be it.

I told him I needed to think about it. I took the next day off from work, did some research on Google Scholar (not much new, except that Doxil had been used on a few ASPS patients, though I couldn't find out how they fared), and stopped by the cancer center the next day with my decision.

I'd be starting Doxil.

It actually makes a lot of sense, the idea of coating the drug with fat, or liposomes, synthetic structures made of fatty layers and water designed to deliver medication. A fat suit for the chemo.

With the fat cells as a protective barrier, the half-life of the drug is extended, making it effective for longer. The fat helps the drug circulate more quickly, and because the treatment isn't unbridled Adriamycin, it doesn't cause as severe side effects or affect the immune system as much.

If I lose hair at all, it will be only a little bit -- "you won't look like me," said Dr. Jahan, whose hairstyle resembles that of a Franciscan monk -- and I'll be on medication ahead of time to help with any nausea that could arise, which Dr. Jahan thought would be minimal.

However, I could develop a rash on my hands or feet, one so severe it has caused other patients to end the treatment. Whoa. And I will be tired. Oh, so tired. Am I ever tired of being tired.

But even that will be different. Because of the toxicity of Adriamycin, I can't be on this drug forever. So if the fatigue is extreme and seems to be getting worse, it'll be nice to know that there's a purpose to it all, larger than just "making it through" yet another exhausting day.

This new route has injected some hope into my heart; since it's all a big unknown, who's to say this won't work? Who's to say the cancer won't shrink, just a little? (Or, dare I say or even whisper, perhaps a lot?)

I was shocked that I handled the news of chemo so well. I understand that it's scary and that there are plenty of aspects to be nervous about and changes to be afraid of. But right now, I'm not. I started analyzing my reaction, listing the ways I'm in denial. Then I thought, OK, I can dwell on the dark side of something I feel OK about ... or I can stop being an idiot.